Broadly speaking, self-injury (also called self-inflicted violence, self-harm, parasuicide, delicate cutting, self-abuse, and self-mutilation) is the actof attempting to alter a mood state by inflicting physical harm serious enough to cause tissue damage to the body. This harm may include cutting (with knives, razors, glass, pin, or any sharp object), burning, hitting the body withan object or fists, hitting a heavy object (like a wall), picking at skin until it bleeds, biting, pulling hair out. The most commonly observed forms arecutting, burning, and headbanging. It is not considered self-injury if the primary purpose is sexual pleasure, body decoration, or spiritual enlightenment through ritual.

The reasons why people engage in self-injurious behavior are numerous: biological predisposition, tension reduction, and lack of experience in dealing with intense emotions are some of the major factors. Studies have suggested thatwhen people who self-injure get emotionally overwhelmed, an act of self-harmbrings their level of psychological and physiological tension and arousal back to a bearable baseline level almost immediately. For this reason, self-injury is often addictive. However, eventually the negative consequences outweigh the immediate benefits, and the individual may feel trapped in a desperatecycle of self-harm.

People who inflict harm on themselves often indulge in the behavior as a waymeans of avoiding suicide. Although some individuals who self-injure do laterattempt suicide, they almost always use a method different from their preferred method of self-harm.

One factor common to most individuals who self-injure is the feeling of invalidation. They are taught at an early age that their feelings are inconsequential or erroneous; they also learn that expressing certain feelings is forbidden. In homes in which these individuals are abused, they may have been severely punished for expressing these thoughts and feelings. Although sexual and physical abuse and neglect may precipitate self-injurious behavior and is often a predictor of the amount and severity of self-injury, many of those who harm themselves have no background of childhood abuse. In addition, those who self-injure usually have not been provided with adequate role models for learning how to deal with stress effectively.

Scientists believe that reduced levels of the brain chemical serotonin may predispose some individuals to self-injury by making them more aggressive and impulsive than most people. This tendency toward impulsive aggression, combined with a belief that their feelings are invalid, can lead to the agression being turned on the self. Once this behavior occurs, the individual harming himor herself learns that self-injury reduces the level of stress, and the cycle begins.

It has been estimated that about 1% of Americans self-injure, and women resort to this behavior more often than men. Although statistics vary, surveys ofthose who self-injure have found that about 85% of are women. The theory is that women are socialized to internalize anger and men to externalize it. It is also possible that because men are socialized to repress all emotion, theymay have less trouble keeping things inside; or they may externalize it in seemingly unrelated violence.

A "portrait" of the self-injurer compiled by researchers found that the typical self-injurer is female, in her mid-20s to early 30s, and has been cuttingherself since her teens. She tends to be middle- or upper-middle-class, intelligent, and from a background of physical and/or sexual abuse or from a homewith at least one alcoholic parent. Eating disorders often coexist with self-injury. In addition, individuals who engage in repetitive self-injury have reported being diagnosed with other disorders, such as depression, obsessive-compulsive disorder, dissociative disorders, anxiety and panic disorders, and impuse-control disorders.

Self-injurers come from all races and socioeconomic levels. Some people who self-injure manage to function effectively in demanding jobs; others resort todisability compensation. They range in age from early teens to early 60s. The incidence of self-injury is reportedly similar to that of eating disorders,but because the disorder is so highly stigmatized even among health care professionals most people hide their scars, burns, and bruises carefully. Sinceself-injury is so socially unacceptable, it is not as understood or acceptedby society as alcoholism, drug abuse, or other forms of addictive, compulsive, or avoidance behavior. Self-injurers are also adept at making excuses whenquestioned about their scars.

Research into medications that stabilize mood, ease depression, and calm anxiety have been found to be effective in treating individuals who self-injure.Hospitalization, it is thought, should only be used as a last resort when thepatient is at risk for suicide or severe self-injury. According to experts,hospitals are artificially safe environments, and the necessary tasks of learning to identify the feelings behind the act and of choosing a less destructive method of coping need to be practiced and reinforced in the outside world.

Many therapeutic approaches have been developed to teach self-injurers effective ways of coping with stress. These approaches reflect a growing belief among mental health professionals that once a patient's pattern of self-inflicted violence stabilizes, real work can be done on the problems and issues underlying the disorder.

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